How To Become A Medicaid Provider In Illinois

Blue Cross Community Health Planssm

Blue Cross and Blue Shield of Illinois offers Blue Cross Community Health Plans which includes a network of independently contracted providers including physicians, hospitals, skilled nursing facilities, ancillary providers, Long-term Services and Support and other health care providers through which Illinois Medicaid members may obtain covered services. Learn more

How Do I Notify The Health Plan Of Additional Visits After The 3rd Visit

Meridian requires notification if you anticipate the member will require more than 3 visits for treatment. The notification must include the DSM-IV diagnosis, reason for continued treatment and status of PCP notification. Please fax the completed Continued Outpatient Treatment Notification Form to 313-202-1268.

What Is The Provider Portal

The Provider Portal is a secure, online tool that allows PCPs, specialists and hospitals to view and create online authorizations and referrals, view specific preventive health care services needed for patients, and verify eligibility and status claims online. The Provider Portal is a real-time information system available to all contracted providers free of charge.

You May Like: Who Is Eligible For Medicaid In Louisiana

How To Become A Medicaid Provider

Providers delivering autism spectrum disorder services must be enrolled with SCDHHS as a Medicaid provider to deliver and bill for Medicaid state plan benefit ASD services.

To enroll with SCDHHS as a Medicaid provider:

*Note, BCBA and BCaBA providers must enroll individually. If there is a group practice, a group enrollment must also be completed.

To enroll with one of the managed care organizations , a provider must be an approved Medicaid provider. Providers need to contact the MCO directly to complete the network enrollment process. Providers are not required to enroll with a MCO, but they may not be reimbursed by the MCO for services provided to beneficiaries enrolled in managed care.

To enroll with a MCO:

• Contact each MCO to begin the process of contracting, credentialing and enrolling.
• MCO contact information:

  Healthy Blue 757-8286

  First Choice by Select Health 741-6605

  Molina Health Care of South Carolina 237-6178

P. O. Box 8206 Columbia, SC 29202-8206 | Email: | phone: 549-0820

Language Services

If your primary language is not English, language assistance services are available to you, free of charge. Call: 1-888-549-0820 .

How Long Does It Take For Medicare To Approve A Provider

A limited sample of 500 Medicare provider enrollment applications processed by nCred with various Medicare intermediaries around the country reveals an average time to completion of 41 days. That average consist of the time that an application is submitted to a carrier until the time the carrier notifies of completion.

You May Like: Is Tenncare And Medicaid The Same Thing

What If A Member Is Transitioning Between Different Managed Care Organizations Or Between Managed Care And Ffs Whether Due To Eligibility Changes Or A Change In Mco Enrollment And Is In The Middle Of A Treatment

Health plans must offer an initial 90day transition period for members new to the plan, in which members may maintain a current course of treatment with a provider who is currently not a part of the plans network. The 90day transition period is applicable to all providers, including Behavioral Health Providers and Providers of LTSS.

How To Become A Medicare Provider In Illinois

Applying to become a Medicare provider

Also Check: Medicaid Salt Lake City Utah

Can An Agency Apply For Multiple Licenses

Yes the applicant shall complete the initial application and select all of the licenses the agency is applying for on page 2 of the application and shall pay the higher of the licensure fees applicable. A home nursing agency or a home service agency shall pay a licensure fee not to exceed $1500. The fee is not refundable. A home nursing placement agency or home services placement agency shall pay a licensure fee not to exceed $500. The fee is not refundable. Home Health Agencies. For a single home health agency license only, each initial and renewal application shall be accompanied by a license fee of $25. The fee is not refundable.

What Is The Process For An Agency To Expand The Geographical Service Area To Service Clients/patients

The agency must seek approval from the Department prior to caring for clients in a new county. The agency shall submit the information outlined on the Forms Home Health Agency Add or Remove Geographic Service Area to the Department contact information below.

Branch Office a location or site from which an agency provides services within a portion of the total geographic area served by the parent agency. The branch office is part of the agency and is located sufficiently close to share administration, supervision and services in a manner that renders it unnecessary for the branch to be independently licensed. To apply for a branch office complete the Home Health Agency Questionnaire under the forms and submit to the Department the contact information on this page.

Recommended Reading: Do I Qualify For Medicaid In Montana

Important Dates And Actions Before The Grand Opening

• Before the IMPACT Provider Enrollment system comes online, there are several important deadlines and activities that providers and administrative staff must be prepared for.These dates only apply to the types of providers that currently enroll in the legacy MMIS. Waiver program providers that enroll in systems other than with the current Medicaid system will continue using

Become A Medicare Provider Or Supplier

Ready to become a Medicare provider or supplier? This guide will help you enroll in three steps.

Do not use this guide if

• Youre a DMEPOS supplier. DMEPOS suppliers should follow the instructions on the Enroll as a DMEPOS Supplier page.
• Youre an institutional provider. If youre enrolling a hospital, critical care facility, skilled nursing facility, home health agency, hospice, or other similar institution, you should use the Medicare Enrollment Guide for Institutional Providers.

Use this guide if any of the following apply:

• Youre a health care provider who wants to bill Medicare for your services and also have the ability to order and certify.
• You dont want to bill Medicare for your services, but you do want enroll in Medicare solely to order and certify.
• You wish to provide services to beneficiaries but do not want to bill Medicare for your services.
• You want to enroll as a supplier who does not dispense or furnish durable medical equipment, prosthetics, orthotics and supplies .

Keep Your Information Current

Its important to keep your enrollment information up to date. To avoid having your Medicare billing privileges revoked, be sure to report the following changes within 30 days:

• a change in ownership

Also Check: Function Of Center For Medicare And Medicaid Services

What Is Considered A Change Of Ownership

License Nontransferable

Oasis Basics And Update Training

IDPH is offering an OASIS Education Session for Home Health providers on April 29 and April 30, 2019 at the James R. Thompson Center , JRTC Conference Room 9-031 at 100 W. Randolph Street, Chicago, IL 60601 from 9 a.m. 4:00 p.m. This session will be covering the OASIS D Basics and Updates information for Home Health Agencies. Home Health Agencies are encouraged to limit representatives to no more than two in order to allow maximum Agencies to participate. There is no cost for attendance however, advanced registration is required as space is limited. NOTE: Attendees must have a valid state ID to enter the building. Please contact the Office of health Care Regulation, Division of Health Care Facilities and Programs at 312/793-2222 for more information and/or to register for this event.

Recommended Reading: Anthem Blue Cross Blue Shield Medicaid Indiana

What Is The Process To Obtain A License

The applicant shall review the Home Health, Home Services and Home Nursing Agency Code Adm. Code 245 to determine which license reflects the services that the agency /business will provide. The applicant shall complete the initial licensing application located in the Forms. The Department has 60 days to conduct an initial review of the application and will contact the applicant for revisions to be submitted for an acceptable application. Upon approval of the application the Department will send a letter requesting, a letter from the applicant as to the agencys readiness for on onsite. The Department will schedule an on onsite survey with the applicant to ensure the agency meets the regulations under Home Health, Home Services and Home Nursing Agency Code Adm. Code 245.

• Initial Application: Home Health, Home Services, Home Nursing and Placement Agency Licensing Initial Application

How Can I Become A Meridian Provider

To become a contracted Meridian provider, call Provider Services at .

In order to ensure and maintain a high level of medical care, all providers are credentialed by Meridian. Appropriate contracts and applications are provided along with a questionnaire regarding office function, personnel and the potential capacity to service more members.

You May Like: Home Health Aide Services Covered By Medicaid

Getting Ready To Enroll: Prerequisite Steps For Providers

Many providers will need to take action before they are ready to enroll or revalidate their information in the IMPACT system. To make sure your enrollment experience is as quick and efficient as possible, please investigate whether you need to complete any of these prerequisite steps before you attempt to enroll or revalidate.

What Is Amd In Illinois

Automated Medication Dispenser Service is a portable, mechanical system that can be programmed to dispense or alert the participant to take non-liquid oral medications in the participant’s residence or other temporary residence in Illinois through auditory, visual or voice reminders to provide tracking and caregiver notification of a missed medication dose and to provide 24-hour technical assistance to the participant and responsible party for the AMD service in the home. The service may provide additional medication specific directions, or prompts to take other medications via other routes such as liquid medications or injections based on individual need.

Also Check: Can I Apply For Medicaid While Pregnant

How Do I Know If Im Eligible For Medicaid Coverage

A Navigator or an Assister is a trained, unbiased professional that can help you and your family find the right health coverage. You can schedule a free, in-person appointment with a Navigator here for help finding out if you are eligible for Medicaid or other public benefits:

How Do I Apply For Medicaid

In some cases, your Medicaid can be backdated up to three months from the day you apply, if you were eligible and had medical expenses during those three months. You may be eligible during the three months before your application date even if you are found ineligible at the time you apply. You must ask for backdating when you apply.

If you arent sure whether you already have Medicaid coverage, you can call the states Automated Voice Recognition System at 1-855-828-4995 with your Recipient Identification Number to see if its active.

Recommended Reading: Can I Use Goodrx If I Have Medicaid

What Is Required For A Relocation Of The Health Care Provider

The health care provider shall complete the IDPH Facility Information Change Form prior to the relocation and submit to the Department. If the Health Care Provider is Medicare certified then the provider shall also complete Medicare Provider enrollment form A and submit to their Medicare fiscal intermediary.

Who Is Eligible And Who Is Not Included In Healthchoice Illinois Managed Care

Medicaid members who previously participated in the mandatory managed care program are included in the new HealthChoice Illinois, in addition to special needs children, children receiving SSI, children in the Medically Fragile Technology Dependent waiver, and DCFS youth. HealthChoice Illinois also expanded managed care to every county in Illinois.

Also Check: Medicaid Administrative Office Columbia Sc

Enrollment & Revalidation Phases

• Enrollment and revalidation will occur in phases.Additionally, enrollment must occur in a particular order so that associations may occur between billing agents, entities and individual providers. You are encouraged to 1) review the Provider Enrollment Timelinefor a high-level overview of the enrollment phases, and 2) check the Glossaryto clarify which enrollment phase applies to your p

How Long Is The Credentialing Process

90 to 120 daysA standard credentialing process takes from 90 to 120 days based on the guidelines. In some cases, the process may be completed within 90 days and sometimes, it can take more than 120 days. Keeping in mind, the complexities in medical credentialing, it is best to hire experts in the field.

You May Like: Does Medicaid Cover Inpatient Alcohol Treatment

How Can I Check A Member’s Eligibility

Members will continue to receive their HFS MEDI card once enrolled with Meridian. They will also receive a Meridian ID card for each member of their family that is enrolled. This card will have our logo, phone number, PCP name and recipient ID number. Providers can continue to use the on-line MEDI system to check eligibility, or they can call Meridian at to confirm benefits.

What Are My Contract Options As A Health Care Provider In The Meridian Network

Primary Care Providers

Meridian contracts with Primary Care Providers on a fee-for-service basis, with quality bonus incentives in lieu of traditional full risk arrangements. Our focus on quality, instead of risk, allows physicians to do what they do best: treat patients.

Specialist Providers

Meridian values the relationship with our specialist providers and seeks to limit the amount of “red tape” whenever possible, especially with referrals and authorizations. Meridian continues to provide prompt claims payment to specialist providers.

Hospital Providers

Communication is the key to all mutually beneficial relationships. In this regard, Meridian makes every effort to partner with each contracted Hospital in coordinating the care of its beneficiaries. Hospital providers can count on Meridian to help serve their communities with as little interference as possible.

You May Like: What Do I Need To Apply For Medicaid

What Is Medicaid

Medicaid is a name for health insurance from the state. It also has other names depending on what type of Medicaid Coverage Group you fit into. For example, the different Coverage Groups are called Moms and Babies, All Kids, Aid to the Aged, Blind, and Disabled , and ACA Adult. Some people also call Medicaid the Medical Card.

Why Meridian

We go the extra mile for you and your patients

• Our Provider Network Development Representatives visit their dedicated primary care offices at least once a monthrain, sleet or snow
• We pay co-pays so you dont have to deal with the hassle

Were one of the fastest growing groups of health plans in the country

• We now serve over 850,000 members and 50,000 providers in Michigan, Illinois and Ohio
• We operate an open network in each state, allowing all providers the opportunity to participate if they choose, provided they meet the credentialing standards established by NCQA, URAC and CMS

Were highly rated and keep getting better

• Meridian Health Plan of Michigan, Inc. and Meridian Health Plan of Illinois, Inc. were both rated 4 out of 5, according to NCQA’s Medicaid Health Insurance Plan Ratings 2017-2018. In addition to being rated 4 out of 5 across all Medicaid plans, NCQA has awarded Meridian Health Plan of Michigan, Inc. and Meridian Health Plan of Illinois, Inc. an Accreditation status of Commendable for service and clinical quality that meet NCQA’s rigorous requirements for consumer protection and quality improvement
• Meridian consistently meets the state performance requirements for timely claims payment

We save your patients money at the pharmacy

We make disease prevention a priority

Recommended Reading: How Long Does It Take To Get Approved For Medicaid